May is both Asian-American and Pacific Islander (AAPI) Heritage Month and Mental Health Awareness Month. Yet in the United States, the AAPI community is the least served ethnic and racial groups when it comes to mental healthcare, despite having the same prevalence of mental illness as other Americans. Only 7.7% of AAPI adults have received mental health services as compared to their non-Hispanic white counterparts at 24.4% [1]. In the United States, anti-Asian rhetoric has been closely on the heels of the COVID-19 pandemic. In one study [2], about a quarter of AAPI university students reported COVID-19 related discrimination based on their AAPI identity. Of these, about 2/3s of the students reported to have depression, anxiety, non-suicidal self-injury, binge drinking, and suicidal ideation.
AAPIs come from distinct cultural and ethnic groups originating from East and Southeast Asia, South Asia, and the Pacific Islands. Despite the many differences in culture and language, there are commonalities in the experiences of AAPI. Understanding the barriers to mental healthcare, including systemic and cultural implications, is key to recognizing and providing these resources to those in need.
Stigma and Shame
Many AAPI groups find strength and resilience within the bonds of community and family. However this strength also can discourage members of AAPI communities from seeking mental healthcare, as the needs of the community and family are often prioritized over the needs of the individual. Especially among first-generation AAPIs, mental health can be dismissed or downplayed due to lack of understanding and association with weakness and shame, which discourages seeking out resources until a crisis hits. Among second-generation AAPIs, cultural and family values can often clash with expectations from American society, creating a sense of not belonging. Stigma and shame can also prevent one from addressing one’s mis-identity, sometimes leading to isolation, depression, and anxiety.
Myth of the Model Minority
While AAPIs have been fighting against the “myth of the model minority” for generations, the remnants of this misconception based in racism haunts many to this day. Societal assumptions that AAPI communities are well-adjusted and norm-conforming negate the very real socioeconomic, health, and mental health challenges that many AAPI groups face. This can lead to lack of resources and pressure to not seek out resources when needed.
Cultural Understanding of Mental Health and Illness
In many AAPI groups, mental and physical health are viewed as one. Often mental illnesses are somaticized or manifested physically, for example, generalized anxiety in the form of chronic GI upset. Often these physical symptoms are overlooked as just physical by healthcare providers, thus misdiagnosed and mistreated. Language barriers and immigration status can also influence access to care.
Insurance and Cost
Among immigrant communities, AAPI individuals historically have had difficulties accessing healthcare services due to lack of insurance. In 2018, about 11% of Asian-Americans lived at or below the poverty line, and 6.2% were without health insurance [3]. In another survey by the CDC [4], 1 in 3 Asian-Americans with a diagnosis of depression were unable to see a doctor due to cost.
Limited Availability of Culturally-Informed Services
AAPI communities make up the largest growing ethnic and racial group in the United States [5]. Yet there is a significant lack of mental health providers who identify as AAPI. Under 5% of psychologists in the U.S. are Asian and Asian American [6], and though this does not account for Asian and AAPI-identified social workers, counselors, and psychiatrists, the demand for services certainly outweigh the supply. This, combined with a gap in research on AAPI mental health needs as well as services and treatments aimed specifically for AAPI, can discourage communities from seeking out care.
Seeking mental healthcare when there is a lack of AAPI-identified mental health providers can be daunting. If you or a loved one needs help and are not sure where to turn to, reaching out to your primary care provider can be the first step. Request a referral to a mental health provider who either identifies as AAPI or is culturally aware of the mental health needs of the AAPI population. Once a provider has been identified, ask questions to make sure it is a good fit, such as:
- Do you have experience treating those from the AAPI community?
- What are your views on the connection between mental health and physical health?
- How will our cultural differences affect my treatment and how we communicate?
The relationship between a client and a mental health provider is built on open communication, respect, and genuine care. A competent provider, whether they identify as AAPI or not, will listen to your concerns and make efforts to understand you and your identity.
Additional Resources
- National Asian American Pacific Islander Mental Health Association: https://www.naapimha.org/
- Asian Mental Health Collective: https://www.asianmhc.org/
- South Asian Mental Health Initiative & Network: https://samhin.org/
Instagram Accounts to Follow
- @asiansdotherapy
- @asiansformentalhealth
- @browngirltherapy
- @projectlotusorg
- @southasiantherapists
Sources
[1] https://www.cdc.gov/nchs/products/databriefs/db419.htm#:~:text=In%202020%2C%2020.3%25%20of%20U.S.,from%20a%20mental%20health%20professional
[2] https://www.frontiersin.org/articles/10.3389/fpsyt.2021.708426/full
https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Asian-American-and-Pacific-Islander
[3] https://www.mhanational.org/issues/asian-american-pacific-islander-communities-and-mental-health
[4] https://www.americanprogress.org/article/4-ways-improve-access-mental-health-services-asian-american-communities/
[5] https://www.apa.org/pi/oema/resources/ethnicity-health/asian-american/psychological-treatment
[6] https://mhanational.org/blog/aapis-we-need-therapists-who-look-us
